Provider Demographics
NPI:1366171068
Name:GAHNAPETYAN, VIOLA
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:
Last Name:GAHNAPETYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 BEVERLY DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1410
Mailing Address - Country:US
Mailing Address - Phone:760-449-4178
Mailing Address - Fax:
Practice Address - Street 1:332 BUSTLETON PIKE REAR
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7856
Practice Address - Country:US
Practice Address - Phone:215-698-2710
Practice Address - Fax:267-392-6126
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO43603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist